Abstract
Introduction
The aim of this study was to evaluate the equianalgesic ratio of transdermal buprenorphine (TD BUP) with oral morphine and TD fentanyl in a sample of consecutive cancer patients receiving stable doses of 120–240 mg of oral morphine or 50–100 µg of TD fentanyl, reporting adequate pain and symptom control.
Materials, methods, and results
Patients receiving daily stable doses of opioids for more than 6 days, with no more than two doses of oral morphine (20 and 40 mg, respectively) as needed, were switched to TD BUP using a fentanyl–BUP ratio of 0.6:0.8 and an oral morphine–BUP ratio of 70:1. Opioid doses, pain and symptom intensity, global satisfaction, and number of breakthrough medication were recorded before switching (T0), 3 days after (T3), and 6 days after (T6). Eleven patients were recruited in a period of 1 year, and data were complete for ten patients. The mean age was 61.6 (SD 9.5), and five patients were males. No significant changes in pain and symptom intensity were found, except improvement in reported constipation (p = 0.014), as well as in global satisfaction with the analgesic treatment. No significant changes in breakthrough pain medication were observed.
Conclusion
The results of this study suggest that stable patients receiving relatively high doses of oral morphine or TD fentanyl could be safely switched to TD BUP, by using a ratio of 70:1 and 0.6:0.8, respectively, maintaining the same level of analgesia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Reference
Christoph T, Kogel B, Schiene K, Friderichs E (2005) Broad analgesic profile of buprenorphine in rodent models of acute and chronic pain. Eur J Pharmacol 507:87–98. doi:10.1016/j.ejphar.2004.11.052
Davis M (2005) Buprenorphine in cancer pain. Support Care Cancer 13:878–887. doi:10.1007/s00520-005-0849-9
Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV (2007) Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec) in chronic pain patients. Pain Pract 7:123–129. doi:10.1111/j.1533-2500.2007.00119.x
Hanks GW, Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Casas JR, Sawe J, Twycross RG, Ventafridda V, Expert Working Group of the Research Network of the European Association for Palliative Care (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593. doi:10.1054/bjoc.2001.1680
Likar R, Krainer B, Sittl R (2008) Challenging the equipotency calculation for transdermal buprenorphine: four case studies. Int J Clin Pract 62:152–156
Mercadante S, Villari P, Ferrera P, Porzio G, Aielli F, Verna L, Casuccio A (2006) Safety and effectiveness of intravenous morphine for breakthrough pain in patients receiving transdermal buprenorphine. J Pain Symptom Manage 32:175–179. doi:10.1016/j.jpainsymman.2006.01.013
Mercadante S, Ferrera P, Villari P (2007) Is there a ceiling effect of transdermal buprenorphine? Preliminary data in cancer patients. Support Care Cancer 15:441–444. doi:10.1007/s00520-006-0169-8
Mercadante S, Porzio G, Fulfaro F, Aielli F, Verna L, Ficorella C, Casuccio A, Riina S, Intravaia G, Mangione S (2007) Switching from transdermal drugs: an observational n of 1 study of fentanyl and buprenorphine. J Pain Symptom Manage 34:532–538. doi:10.1016/j.jpainsymman.2007.01.006
Sittl R, Griessinger N, Likar R (2003) Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders: a multicenter, randomised, double-blind, placebo-controlled trial. Clin Ther 23:150–168. doi:10.1016/S0149-2918(03)90019-1
Sittl R, Likar R, Pousen Nautrup B (2005) Equipotent doses of transdermal fentanyl and transdermal buprenorphine in patients with cancer and non cancer pain: results of a retrospective cohort study. Clin Ther 27:225–237. doi:10.1016/j.clinthera.2005.02.012
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mercadante, S., Casuccio, A., Tirelli, W. et al. Equipotent doses to switch from high doses of opioids to transdermal buprenorphine. Support Care Cancer 17, 715–718 (2009). https://doi.org/10.1007/s00520-008-0546-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-008-0546-6